The SARAH Medicines Access Framework consists of the five major pillarsas reflected on the Philippine Medicines Strategy 2011-2015 that these are necessary to ensure that essential and quality medicines are accessible and available towards achievement of the better health outcomes for all Filipinos. SARAH articulates the values and principles that all stakeholders must pursue and adopt in a transparent, participative and harmonious manner to contribute to the achievement health system goals.

The SARAH medicines access framework outlines the five pillars for targeted and sustained action by the health and relevant sectors, namely: 1)Safety, Efficacy and Quality (SEQ) of medicines, 2) Affordability and availability, 3) Rational use of medicines, 4) Accountability, transparency and good governance and 5) Health System Support.

Safety, Efficacy and Quality (SEQ)

Safety, Efficacy and Quality (SEQ) is the first pillar of the PMP which includes all policies and strategies employed by the state and the tools for all stakeholders to constantly assure the safety, efficacy and quality of essential medicines along the supply chain and at all levels of care. This component shall ensure that the manufacturer packaging, procurement, import, export, distribution, supply and the sale of drugs, produc promotion and advertising and clinical trial are carried out according to specified standards of safety, efficacy and quality. FDA shall be the lead agency in the settinf of such standards for medicines and in adopting internationally accepted standards that will apply to the local situation in coordination with other appropriate government regulatory bodies.

Affordability and Availability

Affordability and Availabilityis the pillar that pertains to the full range of mechanisms that government shall employ in a collborative endeavour with all partners and sectors to ensure that Filipinos have adequate and timely access to medicines at all points of health service delivery. Likewise, government shall exercise its power to influence the local supply and demand of medicines through strategies that promote effective competition as well as transparent and rational pricing to assure that medicines are affordable to the individual, families and communities.

The adoption and use of generics shall be actively promoted in both the public and private sectors as government commits to increase financing for medicines and deliver the best health outcomes to more patients. Essential drug packages, once declared as entitlements by government, shall be provided for free or with reasonable co-payments for patients either through direct subsidy by the DOH or social health insurance and any other payment schemes of government. Drug prices shall be actively monitored by the DOH enabling transparent and objective price information sharing with drug procuring entities, consumers, health professionals and the public.

Other policy instrument shall be explored to reduce out-of-pocket spending such as reducing taxes on medicines, price negotiations with industry and tailored pooled procurement to ensure economies of scale. Government in cooperation with the private sector shall also exhaust patent flexibilities in making medicines, particularly single source products which are expensive but which are deemed to address diseases of public health concern in the country readily accessible to Filipinos.

Government shall also exert its power where necessary to regulate prices of medicines when market forces fail to make them affordable and accessible with the intent to improve health outcomes, as provided for by law.

Rational use of Medicines (RUM)

Rational use of Medicines (RUM) World Health Organization (WHO) defines rational drug use as the condition where "patients receive medicines appropriate for their clinical needs, in doses that meet their individual requirements, for an adequate period of time, and at the lowest possible cost to them and their communities."

The DOH in collaboration with health providers as well as patients and consumers shall promote the rational and cost-effective use of medicines to achieve the best treament outcomes for patients while generating efficiency and cost-savings in the healthcare system. The Philippine National Formulary (PNF) current edition shall be the basis of selection and procurement of medicines in all public health facilities. The PNF shall also govern the reimbursement of drugs by Philhealth in both public and private health facilities.

Patients and consumers shall be educated and informed on the quality, safety and proper use of medicines as well as their right to demand low-cost medicines through generic substitution. Health providers shall be educated on rational prescribing based on nationally accepted treatment guidelines as well as proper dispensing to eliminate unnecessary prescriptions, halth the emergence of antibiotic resistance and ensure that government funds are used for medicines that achieve the best health outcomes.

To ensure checks and balances in the provision of services related to medicines, the prescription, dispensing, safety monitoring and administration of medicines by health professionals shall be governed by laws that reglate their practice.

Accountability, Transparency and Good Governance

Accountability, Transparency and Good Governance this pillar is anchored on the fact that strategies to improve access to medicines can only happen within a framework that institutionalizes accountability, transparency and good governance in regulatory and management systems along the medicines supply chain.

Building on the gains and efforts of the Philippines as a pilot country for the WHO Good Governance in Medicines (GGM) program, Government shall continue to develop approaches and strategies to enforce rules, promote good practices and reduce vulnerabilities to corruption in the health system. Strategies shall include improving regulatory standards, building transparent and efficient support systems for medicines procurement and logistics management, developing performance tracking mechanisms, managing risks of corrupt practices and giving incentives to foster positive behavior of players.

Government shall encourage the industry and health providers to comply with laws and standards, pursue ethical research and development and uphold responsible and ethical business practices. Integrity development activities shall be continually pursued to promote proper norms of behavior and codes of conduct of health workers and professionals. Conflicts of interest shall be declared and managed to ensure that these do not adversely influence critical decisions, policies and strategies that aim to improve access to medicines.

To achieve transparency, a synergistic and constructive multi-stakeholder approach shall be fostered to address vulnerable areas of inefficiencies and corruption in medicines management.

To ensure efficiency in the provision of medicines, Government shall exert all efforts to address red tape and bottlenecks in the system and to strealine bureaucratic procedures while maintaining quality standards to enhance the delivery of medicines and other health services.

Health System Support

Health Systems Support this pillar cuts across all the other components of the PMP with the government exercising its prime responsibility as key enabler.

The DOH recognizes that scaling up access to essential medicines needs to happen within an environment where there are enabling human, technical, technological and financial resources and instruments. A strong health system must be builet to successfully implement the different pillars of the Philippine Medicines Policy. Thus, there must be absolute commitment from all stake holders to marshal the needed health systems support comprising of additional financial investments, adequate and trained human resources, up to date knowledge-base/evidence, Information and Communications Technology (ICT), efficient systems and processes and incentives for good practices in drug management.

In line with Millennium Development Goal 8 to foster global partnership for development, Government shall pursue Public Private Partnerships (PPP) through various initiatives such as price-reduction schemes, increasing access points for medicines access programs, technology transfer, sharing of resources and expertise, research and development, among others.